Does Chemotherapy Improve Outcomes in Recurrent Endometrial Cancer Treated with Radiation Therapy?

A randomized trial comparing radiation therapy alone to combined chemotherapy and radiation therapy (chemoradiation) for women with localized recurrent endometrial cancer found that radiation therapy alone resulted in superior progression-free survival (PFS) and fewer acute toxicities.

Endometrial cancer frequently recurs in the pelvis, with the vagina being a common site of relapse. While chemotherapy is often added to radiation therapy for recurrent disease, limited evidence supports its benefit in improving outcomes. This trial aimed to clarify whether adding chemotherapy to radiation therapy improves PFS in this patient population.

The study involved 165 women randomly assigned to receive either radiation therapy alone or chemoradiation between February 2008 and August 2020. Participants primarily had low-grade endometrioid histology (82%) and vaginal recurrences (86%). Radiation therapy involved external beam treatment with either three-dimensional or intensity-modulated techniques, followed by a boost with brachytherapy or external beam. The chemoradiation group received weekly cisplatin (40 mg/m²).

The median PFS was longer in patients treated with radiation therapy alone compared with those who received chemoradiation (median PFS was not reached for radiation therapy vs 73 months for chemoradiation; hazard ratio = 1.25; 95% CI, 0.75–2.07). At 3 years, 73% of patients treated with radiation therapy alone were alive and free of disease progression, compared with 62% in the chemoradiation group. Rates of acute toxicity were higher in the chemoradiation group.

“Excellent outcomes can be achieved for women with localized recurrences of endometrial cancer when treated with radiation therapy. The addition of chemotherapy does not improve progression-free survival for patients treated with definitive radiation therapy for recurrent endometrial cancer and increases acute toxicity,” the study authors concluded.

Reference

Klopp AH, Enserro D, Powell M, et al. Radiation therapy with or without cisplatin for local recurrences of endometrial cancer: results from an NRG oncology/GOG prospective randomized multicenter clinical trial. J Clin Oncol. 2024;42(20):2425-2435. doi:10.1200/JCO.23.01279